Violence Prevention in Health Care Settings

1. Violence Prevention in Health Care Settings

2. Background • Violence is escalating in health care • Recent BLS data shows an annual rate of 8.3 assaults per 10,000 HCWs • Compared to a rate of 2 per 10,000 for all private-sector industries. • The actual incidence rate of violence in health care is likely to be greater due to lack of reporting

3. Background • Risk factors • Working with volatile people • Working with those under the influence of alcohol or drugs • Working when understaffed • Transporting patients • Long waits for service • Overcrowded, uncomfortable waiting rooms • Working alone • Inadequate security • Lack of staff training

4. Background • RCW 49.19 was passed in 1999. This law requires “health care settings” to develop and implement plans “to reasonably protect employees from violence.”

5. Scope • Hospitals * • Home health • Hospice • Evaluation & treatment facilities • Community mental health programs • Psychiatric hospitals and long-term care facilities (i.e., nursing homes) not included. • State Psychiatric facilities covered under RCW 70.23

6. “Violence” or “Violent Act” “Any physical assault or verbal threat of physical assault against an employee of a health care setting”

7. Workplace Violence Plan “Each health care setting shall develop and implement a plan to reasonably prevent and protect employees from violence…”

8. WPV Plan includes: • Security and Safety Assessment • Physical attributes of setting • Staffing (including security) • Personnel policies • First aid & emergency procedures • Reporting of violent acts • Education and training

9. WPV Plan: security and safety assessment • Hazard assessment identifies causes and consequences of violent acts in preceding 5 years, or for length that records are available in home care/hospice • Guidelines from any appropriate agency may be used for assessment

10. Training • Provided to all affected employees within 90 days of hire. • On a “regular basis” thereafter. • Temporary workers: employer must take into account “unique” circumstances. • May include classes, video, written materials as appropriate

11. Training Contents* • General and personal safety procedures • Violence escalation cycle • Violence-predicting factors • Obtaining a patient history from a patient with violent behavior • Techniques to de-escalate violent acts • Strategies to avoid physical harm • elements included as appropriate

12. Training Contents (as appropriate) • Restraining techniques • Appropriate use of physical and chemical restraints • Reporting of incidents • Debriefing procedures • Resources for employees for coping with violence • Facility’s WPV Plan

13. Records • Records must be kept of any violent act against an employee, a patient, or a visitor: • Setting name & address • Date, time, specific location • Name, job title, department or ward, and staff id (if an employee) • Description of victim and perpetrator (i.e., patient, visitor, employee, other)

14. Records (By July 1, 2000) • Description of violent act • Threat • Assault (with or without injury/death) • Body part injured • Weapon used • Number of employees in area • Actions taken by co-workers or facility in response to violent act • Records kept for 5 years and available to L&I upon request

15. RCW 72.23: Violence Prevention in State Psychiatric Hospitals • WPV Plan must be updated annually • Training must be given prior to assignment • Training must be provided annually • List of training elements required for inclusion is expanded • except for removal of a reference to the use of medications as chemical restraints.

16. Compliance • WISHA enforces RCWs • Citations will use: • Safe Place (WAC 296-24-020) • Accident Prevention Program (WAC 296-24-040) • Also see, WRD 5.05 Violence in the Workplace (1997). • http://www.lni.wa.gov/wisha/regs/wrds/ wrd505.htm

17. Possible Citations (1) • Failure to develop violence prevention plan: Serious violations of WAC 296-24-040 where a related serious violation is cited or where a related serious hazard has been documented. Otherwise, cited as general.

18. Possible Citations (2) • Failure to provide training as required: • Serious violations of WAC 296-24-020(1)(c), management responsibility to provide training, for failure to provide training necessary for safe job performance (referencing the statute) where a related serious hazard has been documented. Otherwise, cite general

19. Possible Citations (3) • Failure to implement features of the violence prevention plan other than training: Serious violations of WAC 296-24-020(1)(b) where a related serious hazard has been documented. Otherwise, cite general.

20. Possible Citations (4) • Citations for missing elements of the required plan will be handled in accordance with the description in Citation 1 - 3 above.

21. Prevention Strategies • Environmental designs • Alarms, metal detectors, cameras • Administrative controls • Staffing patterns, restrict public movement • Behavior modifications • Training

22. More Information • L&I Consultation Program • Check the blue government section of the white pages; or the LNI web page • Alan Lundeen • lund235@lni.wa.gov • 360.902.5154 • John Furman • furk235@lni.wa.gov • 360.902.5666

23. More Information • WISHA/Policy and Technical Services Web Page on Violence Prevention: • http://www.lni.wa.gov/wisha/ • Chose Workplace Violence Prevention from the Topics List